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anxiety disorders, panic attacks, hyperventilation


  • all people have periods of anxiety
  • it may become troublesome and regarded as a disorder if it becomes persistent, or is out of proportion to what would be expected and interferes with functioning.
  • personality style may be a critical cause of anxiety and in these cases, patients are unlikely to respond to drug Rx alone.
  • most people can be managed with self-help programs although some may warrant referral to a clinical psychologist, and some may require pharmacologic assistance after pre-treatment counselling.
  • substance abuse including alcohol use tends to increase anxiety disorders
  • do not forget to exclude agitated depression and suicidality as a differential diagnosis

self-help programs

  • Anxiety Online - an Aust. Govt funded website developed by Swinburne Uni
  • This Way Up - an initiative of the Sydney St Vincent's Hospital Clinical Research Unit
  • eCentre Clinic - developed by Macquarie University

pharmacotherapy for anxiety

pre-Rx counselling

  • most agents will have initial mild adverse effects such as nausea, headache and dizziness, and anxious patients may interpret these as indicating they may have a serious medical problem
  • it is thus important to spend time beforehand to discuss these issues and the fact, it will take some 4-6 weeks before benefit starts, and to start on a low dose for a few days to a week
  • allow at least 4-6 weeks for the minimum recommended dose to work before increasing to higher doses
  • most patients should be considered for Rx duration of around 1 year
  • if inadequate response after good duration of Rx, consider changing to another SSRI
  • consider adding cognitive behavioural Rx after some symptomatic improvement has occurred

1st line Rx

  • historically benzodiazepines were used as 1st line anxiolytics have their use has some disadvantages such as cognitive impairment, dependence and anxiety-producing withdrawal period which preclude their utility as 1st line agents
  • current 1st line agents now should be SSRI/SNRI antidepressants
    • Rx dose may vary according to disorder, for example:
      • fluoxetine:
        • usual dose 20-40mg/d
        • panic disorder may require up to 60mg/d
        • OCD may require up to 80mg/d
  • a very short course of benzodiazepines for only a few days to a week may be indicated to get patients through a particularly stressful period

other agents

anxiety.txt · Last modified: 2013/12/23 17:30 (external edit)